Case study for nursing-heart disease-myocardial infarction - Essay Example

Question In no more than 400-450 words, identify the most important nursing interventions relevant to Trina’s needs and the rationale for these asyou assess her. Your answer should demonstrate an understanding of the treatment ordered by the medical officer (i.e. oxygen, medical tests, medications and type of fluid).Trina has a history of asthma and is suffering from exacerbation of an asthmatic attack probably due to contact with an allergen during her holiday, excessive exercise or it could have been precipitated due to temperature change.

Lack of response to the normal dose of salbutamol, persistent wheezing, and breathlessness show that she is suffering from ‘status asthmaticus’. This is an emergency situation and she needs immediate medical attention. An appropriate dose of bronchodilator, preferably in combination with a corticosteroid can reverse the condition. This is the rationale for the administration of 3 doses of salbutamol through a metered dose inhaler. This is aimed at reducing the bronchospasm. Salbutamol is a selective β2 adrenergic receptor agonist which predominates in lung tissue.

When administered in inhalant form, the drug exerts immediate action on the bronchial smooth muscles. It hastens the relaxation of the bronchial smooth muscles. Oxygen therapy has been suggested as she has suffered this exacerbation for quite some time now and although the SpO2 and SaO2 levels are within normal limits; oxygen therapy will hasten her recovery as lung efficiency is presently compromised. This will also prevent any ongoing imbalance within the arterial blood gases and aid in better oxygenation of the blood which is to be carried to the vital organs.

Patients in status asthmaticus usually have elevated plasma antidiuretic hormone levels and this can disturb the water and electrolyte balance. This is the reason for the suggested administration of N/2 saline. Fluid therapy will restore the electrolyte balance and bring about homeostasis in the body. Ipratropium is a mast cell stabilizer and will prevent the further release of histamine and other mediators which contract the respiratory smooth muscles. Prednisolone is a potent corticosteroid which has a marked anti inflammatory action and is therefore prescribed for three days in order to suppress further inflammation within the respiratory tract.

The dosage needs to be continued for a short period of three days or more and can be suddenly stopped although corticosteroids are known to suppress the normal synthesis and release of glucocorticoids by the adrenals. Corticosteroid therapy aids in reducing bronchospasm, airway inflammation, reduces cellular infiltration and oedema and helps in the lysis of mucous plugs in the respiratory tract. Asthmatic attacks are usually IgE mediated and involve an eosinophilic infiltration with concurrent release of various mediators of bronchospasm which include histamine, serotonin and prostaglandins.

A corticosteroid like prednisolone is therefore the preferred drug in treating emergency conditions like status asthmaticus, as effective therapeutic levels can be attained with oral therapy.Question 2Mr Brian Johnson is a 50 year old management executive who presents to the Emergency Department with a sudden onset of shortness of breath and left sided chest pain whilst watching the evening news. The pain has been constant for one (1) hr. He has no relevant past history and he is taking no regular medications.

He is 170 cm tall and weighs 110kg. The age of the patient and the presented symptoms are suggestive of a cardiac condition as persistent left sided chest pain and sudden onset of shortness of breath are indicative of underlying cardiomyopathy. His height and weight are suggestive of obesity and a high body mass index. As Mr. Johnson is a management executive, his life style is suggestive of a sedentary nature. His gross physical body parameters are indicative of excess load on the heart which can precipitate a heart attack at the slightest over exertion.

The pain scale of 9/10 suggests the grave condition of the patient who needs immediate life saving interventions. The elevated heart rate (90) and blood pressure (160/100) and the suppressed respiration (RR 20) indicate that he is suffering from hypertension and cardiac insufficiency. He is in imminent danger of suffering an acute heart attack. This is the reason for the continuous monitoring of his heart rate and ECG on admission to the hospital. The ECG is suggestive of cardiac arrhythmias due to myocardial infarction as there is suppression of the P wave in the aVR, aVL, aVF & II leads at one stage although there is sign of recovery towards the end.

This calls for immediate oxygen supplementation in order to prevent any damage to the cardiac tissue. The R-R interval and the QRS intervals appear OK and the patient needs stabilization of both heart rate and blood pressure.Intra venous administration of Morphine is indicated because it is a potent opiod analgesic and will relieve the intense pain being suffered by the patient and will also aid in monitoring and the administration of further medication. 300 mg. Aspirin stat will help in the thinning of blood and ensure better circulation to the vital organs, especially the heart which will decrease the risk of increase in the size of the myocardial infarct.

Atenolol is a β blocker which will rapidly restore the blood pressure to normal levels. The EUC, FBT, LFT and BSL results will indicate and guide the subsequent therapeutic interventions depending upon the co presence of co morbidities if any in the liver, blood and the presence or absence of diabetes. His CK level (240 U/L) is within normal limits and so is the Troponin level (1-0.9 ng/ml). The prognosis for Mr. Johnson is good but he needs to bring down his weight in order to eliminate the risk of myocardial infarction.